Functional Neuroradiology w wwwwwwwwwwwwwww Scott H. Faro • Feroze B. Mohamed Editors Meng Law Associate Editor John L. Ulmer Diffusion Tensor Imaging Section Editor Functional Neuroradiology Principles and Clinical Applications Editors Scott H. Faro, MD Feroze B. Mohamed, PhD Professor of Radiology, Electrical and Computer Associate Professor of Radiology Engineering, Vice Chair of Radiology Associate Director of Functional Brain Director of Neuroradiology, Functional Brain Imaging Center Imaging Center and Clinical MRI Temple University School of Medicine Temple University School of Medicine 3401 North Broad Street 3401 North Broad Street Philadelphia, PA 19140-5103 Philadelphia, PA 19140-5103 USA USA [email protected] [email protected] Diffusion Tensor Imaging Section Editor Associate Editor John L. Ulmer, MD Meng Law, MD Professor of Radiology Professor of Radiology and Neurosurgery Director of Neuroradiology Director of Neuroradiology Medical College of Wisconsin Los Angeles County Hospital 8701 Watertown Plank Road and USC Medical Center Milwaukee, WI 53226 Keck School of Medicine USA University of Southern California [email protected] 1520 San Pablo Street, HCC II, Suite L 1600 Los Angeles, CA 90033 USA [email protected] Additional material to this book can be downloaded from http://extras.springer.com ISBN 978-1-4419-0343-3 e-ISBN 978-1-4419-0345-7 DOI 10.1007/978-1-4419-0345-7 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2011931860 © Springer Science+Business Media, LLC 2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Preface Functional neuroradiology represents a relatively new and ever growing subspecialty in the field of neuroradiology. Neuroradiology has evolved beyond anatomy and basic tissue signal characteristics and strives to understand the underlying physiological processes of CNS dis- ease. This new and exciting field uses a variety of advanced imaging techniques that are con- stantly expanding due to ongoing research in one of the most advanced fields of medicine. These techniques are initially used to characterize primarily central nervous system lesions using diffusion, perfusion, permeability, MR spectroscopy, and positron emission tomography. Following lesion characterization, localization of the eloquent cortex and key white matter structures is then obtained with state-of-the-art blood oxygen level-dependent (BOLD) fMRI and diffusion tensor imaging (DTI) techniques. This book is a comprehensive review and offers a complete introduction to cutting edge functional imaging in neuroradiology, including the physical principles and clinical applica- tions of these advanced techniques. This book contains 49 chapters and is divided into nine major sections. These sections include a review of the physical principles of all key functional techniques. Lesion characterization is presented using diffusion, perfusion, permeability, MR spectroscopy, and positron emission tomography. There is an overview of BOLD fMRI physical principles and key concepts, including scanning methodologies; experimental research design; data anal- ysis; neurovascular uncoupling and functional connectivity. After characterization of a lesion, the book follows the clinical path of localizing eloquent cortex and white matter using BOLD fMRI and DTI as part of a presurgical mapping procedure. Current and future clinical applica- tions of BOLD fMRI in neurosurgery, neurology, psychiatry, neuropsychology, and neurop- harmacology are also presented. There is an indepth review of multimodality functional imaging that follows an algorithmic approach to brain lesion characterization as well as addi- tional chapters on common brain abnormalities such as epilepsy, traumatic brain injury, and demyelinating disease. A section on imaging techniques that are not based on proton imaging is also presented and it includes magnetoencephalography; positron emission tomography; molecular imaging; and metabolic imaging. This is followed by a section on DTI and BOLD fMRI of the spine and cerebral spinal fluid flow imaging. Finally, a full-color neuroanatomical brain atlas of eloquent cortex and key white matter tracts and a review of BOLD fMRI paradigms are presented. The field of functional neuroradiology is young. There is a great interest and need to continue to advance this area of radiology. Functional neuroradiology represents a vital sub specialty with important clinical applications and great opportunities for clinical and cognitive v vi Preface neuroscience research. It is our hope that this book will give a thorough introduction to this new field and will be a reference, to all physicians and cognitive neuroscientists, of the current and emerging clinical applications of functional neuroradiology. Philadelphia, PA Scott H. Faro Philadelphia, PA Feroze B. Mohamed Los Angeles, CA Meng Law Acknowledgements I want to thank my dear wife Paula for her remarkable patience and continued support in all of my projects. I would like to thank Dr. Anita Pruzan-Hotchkiss, my first scientific mentor, and long time friend who taught me that there is no such thing as a ridiculous question. I would like to thank my mentors and colleagues from my molecular biology graduate program, diagnostic radiology residency - same same, and adult and pediatric neuroradiology fellowship training programs for their encouragement of my academic pursuits. I thank Dr. Raymond Damadian, a pioneer in MRI technology, who I have been honored to get to know and who has helped to inspire my interest in MR physics. All of these individuals lead by example by their tireless enthusiasm, work ethic, academic achievements and kind nature and fostered my great interest in teaching and research. I thank, whole heartily, all of the contributors of this book, for their participation which is truly a labor of love. I am honored to call all of them my colleagues. I want to also thank Dr. Chip Jungreis and all of my neuroradiology colleagues at Temple for their support that gave me the opportunity to put this book together. I have a special thanks to Feroze Mohamed, my long time friend and colleague who is a daily inspiration and has supported me and our work for almost twenty years. I would like to thank my Sensei’s Merrick and Traci and my students, domo arigato gozaima su. I also thank my parents Leonard and Alice and my brother Jeff and my sister Joan for their continued support. Eddie man, thank you, come here buddy. Lastly, I would like to thank my friends at Springer, especially Andrew Moyer, and Maureen Pierce who share our goal to produce this timely book on this exciting and important topic of the physical principles and clinical applications of functional neuroradiology. Scott H. Faro, MD I am extremely grateful to Shaila for being patient and supportive of this project. She was a great sounding board during the years it took to compile this book. Another person I owe my deepest gratitude is Prof. Simon Vinitski, who not only generously guided me in the research project for my doctoral work, but also inspired me to pursue academia with undeterred zeal. I also cannot but mention my parents, Mohamed and Subaidha Ali, and my brothers, without whose encouragement I would not be here writing, and compiling work for, this book. More specifically, I would like to thank the authors of the various chapters of this book. They should know that this book is essentially a reflection of their work, which, in many instances, is the result of years of research. I would be remiss if I did not mention Scott Faro, whose friendship vii viii Acknowledgements and assistance have influenced a good deal of my academic work. Finally, I wish to express my appreciation to Andrew Moyer, of Springer for his coordination of the efforts of the various people that made this book possible, and to Maureen Pierce for her meticulous editorial work. Feroze B. Mohamed, PhD To my parents, Lawrence and Sue, for their love and inspiration. Meng Law, MD Contents Part I Diffusion and Perfusion Imaging 1 Physical Principles of Diffusion Imaging ............................................................... 3 Thinesh Sivapatham and Elias R. Melhem 2 Clinical Applications of Diffusion ........................................................................... 13 Reza Forghani and Pamela W. Schaefer 3 Physical Principles of MR Perfusion and Permeability Imaging: Gadolinium Bolus Technique .................................................................................. 53 Mark S. Shiroishi, Saulo Lacerda, Xiaoli Tang, Naira Muradyan, Timothy P.L. Roberts, and Meng Law 4 Non-gadolinium Perfusion Technique (Arterial Spin Labeling) ......................... 61 Huan Tan and Jonathan H. Burdette 5 Clinical Applications of MR Perfusion Imaging ................................................... 71 Ronald L. Wolf 6 Stroke: Clinical Application of Perfusion and Diffusion ...................................... 107 Niloy Dasgupta and Max Wintermark 7 Clinical Applications of Dynamic Contrast-Enhanced (DCE) Permeability Imaging .............................................................................................. 117 Saulo Lacerda, Mark S. Shiroishi, and Meng Law Part II Magnetic Resonance Spectroscopy 8 Magnetic Resonance Spectroscopy: Physical Principles ...................................... 141 Stefan Blüml 9 Magnetic Resonance Spectroscopy: Clinical Applications ................................... 155 Alena Horská and Ivan Tkáč Part III Multi Modality Functional Neuroradiology 10 Functional Imaging-Based Diagnostic Strategy: Intra-axial Brain Masses ......................................................................................... 197 Arastoo Vossough and Seyed Ali Nabavizadeh 11 Functional Neuroimaging of Epilepsy .................................................................... 221 Noriko Salamon ix